August 9, 2010

BehindTheMedspeak: Quality of Death Index

Customer-satisfaction surveys are commonly use to improve the service in hotels and shops. Alas, they are unsuitable
for rating the quality of death. So the Lien Foundation, a charity,
commissioned the Economist Intelligence Unit, our sister company, to
devise a ranking of end-of-life care. The report, published on July
14th, rates 40 mostly rich countries by how well they care for the
dying.

Britain tops the table. For all the health-care system’s faults,
British doctors tend to be honest about prognoses. The mortally ill get
plentiful pain killers. A well-established hospice movement cares for
people near death, although only 4% of deaths occur in them. For
similar reasons, Australia and New Zealand rank highly too.

Some countries, such as Denmark and Finland, that normally score
higher than Britain on human-development indices rank lower on the
quality-of-death index. They concentrate more on preventing death
(which they see as a medical failure) rather than on helping people die
without suffering pain, discomfort and distress. America scores poorly
because of the health insurers’ rule that they pay for palliative care
only if a patient relinquishes curative treatments.

The report
combines hard statistics such as life expectancy and health-care
spending as a share of GDP with weighted assessments of other
indicators. One is the public awareness of the availability of
hospices. Another is whether a country has a formal policy or
legislation on treating the terminally ill (only seven of the 40 do).

Brazil, China, India and Russia, the four largest emerging
economies, cluster at the bottom of the table. Their health-care
systems still take little account of dignity in death (a sprinkling of
hospices in places such as St Petersburg in Russia, or Kerala in India,
are honourable exceptions). The report’s authors blame cultural factors
as well as bureaucratic resistance. In China, for example, a strong
taboo hangs over discussing death. The ranking may spur improvement.
But for those who mind most, complaining about poor deathbed treatment
is unusually difficult.